Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany;
Neuropsychiatr Dis Treat. 2011;7:103-10. doi: 10.2147/NDT.S8895. Epub 2011 Mar 7.
Implementation of guidelines can improve clinical practice. The aim in this study was to investigate whether neurologists in Germany adhered to the national Parkinson's disease guideline. Data were obtained from a cross-sectional survey of 60 neurologists. Analyses were performed on 320 patients with idiopathic Parkinson's disease with either low grades of functional impairment (Hoehn and Yahr stage I) or higher grades of functional impairment (stage II-V) but without motor complications. The sample was divided into four groups depending on age and grade of functional impairment. For each group, a biometric parameter on the use of dopamine agonists and L-dopa was defined based on the guideline. In patients aged <70 years, the recommendation to use dopamine agonists without L-dopa (parameter 1) was observed in 53% of patients with lower grades of functional impairment, whilst recommended use of dopamine agonists in more functionally impaired patients (parameter 2) was followed to a greater extent (84%). In patients aged ≥70 years, recommendations to use L-dopa without dopamine agonists were adhered to in only 50% of less functionally impaired (parameter 3) and 52% of more functionally impaired (parameter 4) patients. In conclusion, our results indicated there was moderate but not full adherence to the guideline.
指南的实施可以改善临床实践。本研究旨在调查德国神经病学家是否遵循国家帕金森病指南。数据来自对 60 名神经病学家的横断面调查。对 320 名特发性帕金森病患者进行了分析，这些患者的功能障碍程度较低（Hoehn 和 Yahr 分期 I）或较高（分期 II-V），但无运动并发症。根据年龄和功能障碍程度，将样本分为四组。对于每个组，根据指南定义了使用多巴胺激动剂和左旋多巴的生物计量参数。在年龄<70 岁的患者中，建议在功能障碍程度较低的患者中不使用左旋多巴（参数 1），这一建议在 53%的患者中得到了遵守，而在功能障碍程度较高的患者中（参数 2），建议更多地使用多巴胺激动剂。在年龄≥70 岁的患者中，建议在功能障碍程度较低的患者（参数 3）中仅 50%和功能障碍程度较高的患者（参数 4）中 52%的患者遵守不使用多巴胺激动剂的左旋多巴的建议。总之，我们的结果表明，指南的遵循程度中等，但并非完全遵循。
